As we all now know, after Hurricane Irma fourteen elderly souls died because the nursing home in which they resided did not have a electricity after the storm. As a consequence, they “overheated” and died. Well, there is good news – the Florida Legislature and Governor have placed $37.1 billion dollars in this year’s fiscal budget to be used across six health care and social service agencies.
Florida’s medicaid program is the largest recipient at $29.2 billion and Children & Family Services receive $1.7 billion. Those living in nursing homes will receive a 25% raise, from $105/m to $130/m. Nursing homes are now required to have generators with enough fuel to cool buildings during elongated power outages. The above monies are all coming from Florida taxpayers but my favorite part of the legislation is not tax based.
Starting this fiscal year, nursing homes (that receive medicaid dollars) will be paid on a set formula. These providers must meet certain “direct patient-care” requirements as well as “quality of care” requirements. In other words, if a nursing home only meets a minimum standard, they will be paid a minimum amount and given a set amount of time in which to bring the ‘home’ up to the formulaic standard. As the homes hire more qualified staff and add amenities to its building and programs – they will receive larger payments. As one law maker put it, they have to spend money, to make money.
As a senior’s advocate I’m thrilled that our state government realized how badly these “homes” were treating their patients. Yet, it took senseless deaths to have a focus placed on how our greatest generation and aging or ailing baby boomers are treated when they can no longer treat themselves. That is where we must be more vigilant.
As I write this, I cannot help but remember the 17 people who died very prematurely at Parkland High School. And, yes, because of the deaths and the student’s activism we’ve put in some stricter state gun regulations. Also many large gun sellers are now refusing to sell to anyone under 21. Still, much like our senior citizens, why must it takes death to examine our mores and ethics.
HOSPITALS — once synonymous with a place to go when you’re REALLY sick is now the last place you want to be unless it’s prescheduled surgery with a doctor you trust. If you’re elderly and/or on Medicare you are treated as a money machine — not a person.
Here’s how it works . . . depending on how sick you are is how quickly you’re seen. If you have an HMO or PPO assigned to your Medicare plan then everything is a predetermined price. If you only have a medicare card then the patient becomes an ATM. This means that the nurses and techs will run as many
tests as reasonably possible (that insurance will pay). The Doctor will review the chart for a “diagnosis” which, in my experience, is usually “inconclusive.”
The first time you go to the ER they will probably let you go home after the inconclusive tests BUT should you go back within 72 hours the hospital will admit you. This is because the insurance companies won’t pay for a second ER visit without a diagnosis and admittance.
Now, here’s what is very important — you cannot let your elderly Mom, Dad and/or relative stay in the Emergency Room by themselves. Here’s why — the administration will have them sign consent forms for numerous tests that do nothing except take up time. Secondly, the treat them horribly! Here is my story:
I took my 90+ Dad to his HMO doc. He was having balance issues with other symptoms that portend a stroke. We rush to the ER and sit in highly uncomfortable chairs with all types of sick people. After approximately 2 hours they call Dad into a “room.” The medical techs hook him up to a glucose drip and leave the room. For the next 3 hours he is taken from one machine to another for test after test. Because my Father is elderly he meekly goes where he’s told. At the end of this interminable afternoon we receive an “inconclusive diagnosis” and he is allowed to go home.
Two nights later the same symptoms occur — my brother calls 911 and Dad is whisked off to the hospital. I get home in time to follow the ambulance to the same hospital where we’d spent the afternoon. I stay with my Father — they finally move him to an ER room and begin to do THE EXACT SAME TESTS they did 48 hours earlier. I question every one. It is now 1 am in the morning — I find blankets and sleep on the floor next to Dad’s bed because they are going admit him. (Remember, if they don’t admit him the hospital won’t be paid.) In every case, with every test, the results were the same as the ones 48 hours earlier BUT now the diagnosis is not inconclusive . . . it’s we need more tests and observation. After two days they allowed him to leave with the diagnosis of dehydration!
Bottom line, if you have an elderly parent or grandparent do not trust the hospital. When either of my parents stay in the hospital overnight we hire a “babysitter”. Yes, it costs money but your loved one doesn’t wake up to an empty room trying to figure out where he or she is. Further, I check the chart constantly to see what is diagnosis and medicine is being used. Truthfully, it’s like having a child — the difference, I’m grateful to be able to reciprocate what was done for me.
We at Parent Your Parents think this is a terrific “true experience” article authored by Jacqueline Marcell. Jacqueline is also the Author of Elder Rage @www.ElderRage.com. Check it out!
Jacqueline Marcell, Author, Elder Rage www.ElderRage.com
For eleven years I pleaded with my challenging elderly father to allow a caregiver to help him with my ailing mother, but he always insisted on taking care of her himself. Every caregiver I hired soon sighed in exasperation, “Jacqueline, I just can’t work with your father. His temper is impossible to handle and he’s not going to accept help until he’s on his knees himself.”
When my father’s inability to continue to care for my mother nearly resulted in her death, I stepped in despite his loud protests. It was so heart-wrenching to have my once-adoring father be so loving one minute and then some trivial little thing would set him off and he’d call me nasty names and throw me out of the house. I took him to several doctors and even a psychiatrist, only to be flabbergasted that he could act charming and sane when he needed to.
Finally, I stumbled upon a thorough neurologist, specialized in dementia, who put my parents through a battery of blood, neurological, memory tests and PET scans. After ruling out numerous reversible forms of dementia such as B-12 and thyroid deficiency, and evaluating their many medications, he shocked me with a diagnosis of Stage One Alzheimer’s in both of my parents – something all their other doctors missed entirely.
What I’d been coping with was the beginning of Alzheimer’s, which begins intermittently and appears to come and go. I didn’t understand that my father was addicted and trapped in his own bad behavior of a lifetime of screaming and yelling to get his way, which was coming out now in intermittent over-the-top irrationality. I also didn’t understand that “demented does not mean dumb” (a concept not widely appreciated) and that he was still socially adjusted never to show his Mr. Hyde side to anyone outside the family. Conversely, my mother was as sweet and lovely as she’d always been.
Alzheimer’s makes up 60-80% of all dementias and there’s no stopping the progression nor is there yet a cure. However, if identified earlythere are some FDA approved medications (more in clinical trials) that in most patients can mask dementia symptoms and keep patients in the early independent stage longer.
Once my parents were treated for the Alzheimer’s, as well as the often-present depression in dementia patients, and then my father’s volatile aggression, I was able to optimize nutrition and fluids with much less resistance. I was also able to manage the constant rollercoaster of challenging behaviors. Instead of logic and reason, I learned to use distraction and redirection. I capitalized on their long-term memories and instead of arguing the facts, I lived in their realities of the moment. I learned to just go-with-the-flow and let the hurtful comments roll off while distracting with a topic of interest from a prepared list.
And most importantly, I was finally able to get my father to accept two wonderful live-in caregivers and not drive them crazy and to quit. Then with the tremendous benefit of Adult Day Health Care five days a week for my parents and a support group for me, everything finally started to fall into place.
Alzheimer’s disease afflicts more than 5.4 million Americans, but millions go undiagnosed for many years because early warning signs are chalked up to stress and a “normal” part of aging. Since 1 in 6 women and 1 in 11 men are afflicted by age 65, and nearly half by age 85, healthcare professionals of every specialty should know the 10 Warning Signs of Alzheimer’s and educate their patients so everyone can save time, pain, money, heartache… and a fortune in Kleenex!
This is an editorial to the Miami Herald written by H. Frances Reaves, Esq., President of Parent Your Parents, in October of 2017. This was written after Hurricane Harvey and Irma and the mirror placed on Senior Services. As we suffer through a very cold winter these words are still prophetic.
IF YOU HAVEN’T SEEN the video of the residents of a nursing home in Houston, Texas sitting in waist high water simply search “video of seniors in waist high water” in your browser – the You Tube video comes right up. School children were evacuated, families were evacuated and who was left behind . . . seniors. Two weeks later, in the aftermath of Irma, 14 seniors die from overheating in a Broward County Nursing Home.
If these seniors had been children the outcry would have been much louder and punishment swifter. An excellent example is the most recent earthquake in Mexico. The school caved in on top of 24 children and four adults. The volunteer rescuers were there within minutes and the TV crews transmitted the entire search and rescue for more than three days. That would not be the case if this had been a senior citizens facility.
Fariola Santiago wrote in her September 24th column that “the elderly are like children, frail, unable to care for themselves, and vulnerable to abuse and negligence. Those who don’t have money or advocates and require round-the-clock care end up in places with deplorable conditions . . .” I agree with Ms. Santiago regarding the elderly but disagree that all nursing homes have deplorable conditions. We also need to remember that, with the exception of one “lonely soul,” everyone had a family . . . and the family did not take them from the ‘deplorable home’ even after they knew about the power failure.
Baby Boomers, Gen Xers and Millennials beware — you, too will be a senior! Seniors, are an older version of who we are today. We espouse the sentiment that, “I only want to live a long life if I have a quality of life” but legally we don’t have a choice once our mind collapses.
What we don’t discuss is that dementia does not take away your intellect, mental pain or physical pain. Dementia takes away the ability to communicate effectively. It also absconds with your memory – which allows we the children to believe that with memory loss there is a loss of all senses. That is not the case. The 14 elders who died felt pain and the first to die truly suffered because they did not have the benefit of hospice care.
No doubt, the staff at this nefarious nursing home was negligent, incompetent and uncaring and they were allowed to function as “caretakers” for years. It took a hurricane and power outage to bring it to light. Had this been a daycare center the negligence would not have been allowed to continue.
As the President of a company who advocates for seniors, finds resources, counsels families and assists in medicaid preparations, my experience shows that most of us face living in a medicaid facility. Unless you have a healthy pension or half a million dollars you will not have the money for dementia care in a private facility. Today that runs between six to seven thousand dollars a month. If you qualify for medicaid, nursing homes run about $700.00 and medicaid picking up the balance.
We must look in the mirror! let’s begin the process of treating our elderly loved ones as our children. Treat them as you treat those around you. Hold the Assisted Living Centers and Medicaid Facilities accountable and — START SAVING!!
I am confident most of you heard the news about the eight seniors who died from overheating. They were all in a licensed “nursing home” in Hollywood Hills. ‘Nursing Home’ is a euphemism for a home for seniors who are at the poverty level and qualify for medicaid.
Nursing homes are like every other industry — they have to make money to survive. In the case of nursing homes they’re paid by the state medicaid fund and it’s per pa
tient. This fund is made up of state and federal dollars. Obama Care expanded medicaid in the states who took the federal dollars but Florida is not one of them.
Bottom line, these are not the luxurious environments for either staff or residents. In my parents case, Mom had been in a lovely residential facility where she was one of three or four people. Her Long Term Care Insurance paid for it. She outlived her two year policy and we had to place her in a Nursing Home. It was our only realistic option as Mom’s care in an Alzheimer’s facility would be close to $7000,00 a month. Mom and Dad couldn’t afford it and neither could the children.
In pursuit of the best we could find, I went to several nursing homes and learned more than I needed to know. All these homes are very austere and it’s a shock! Bare floors, usually
formica, and waiting rooms with plastic chairs. Almost all the receptionists were behind a barrier — some better designed than others.
The patient population is made up of mostly Alzheimers and Dementia sufferers. All the residents are in a wheel chair, a portable bed or never moved from their beds.
Another surprise, the aides often use pulleys attached to patients to change their clothes, move them to the shower or simply change their diapers. Depending on the home, these medical aides must change and clean about 19 patients each. Some work in tandem others work solo — it all depends on the chore.
Further, most patients are only bathed twice a week, maximum three times a week. During one of these showers their hair is washed. Bottom line, it’s not how we envision our last days, weeks, months or years of life.
On the good side, the ‘better nursing homes’ have excellent care. They hire a team of Geriatric Doctors that include Psychiatrists. These Geriatric groups come to the Nursing Home through a PPO and the doctors physically visit once a month. There is usually a Podiatrist group that also visits once a month (Medicare pays for podiatry services) and a dentist who comes once a quarter. The day to day care is with the Registered Nurses (RNs), Licensed Professional Nurses (LPNs), physical therapists and medical technicians. They also have a contracted Hospice service.
Here are some tips when you need to look for a nursing home:
What is the turn-over rate of its employees
Needless to say, the less turnover the better the place. If the staff is not leaving then something is going well — usually their paid above average wages
Is there a hair salon
If there is a hair salon then there’s a market for it. This means the residents take pride in how they look. People who take pride in themselves care about their environment.
Is it clean
As we all know, cleanliness is godliness
Is there a smell
Again, if it smells that means it’s really not clean – no matter how good it looks
Is there a smile on the faces of the staff
A smiling staff means a happy staff
Again, hopefully it doesn’t come to this but if it does, know how to choose the best one.